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Allergy & Immunology • Primary Immunodeficiency
Do you recommend weekly SQ immunoglobulin replacement for an asplenic patient who only responded to 4/23 pneumococcal serotypes after the Prevnar 20 vaccine?
I have a patient who has had their spleen removed and cannot make antibodies to pneumococcal polysaccharide. She had Prevnar 20 and only responded with positive titers in 4 of 23 types tested. She has a history of recurrent pneumonia as well. Her IgG level is 926. What dose of IgG subcutaneous weekly supplementation would be appropriate for this patient? How many grams per week would you start her on?
See related question: What are the implications of checking post-vaccine titers after administration of Prevnar 20 compared to PPSV23?
Answer from: at Academic Institution
Immunoglobulin replacement therapy is indicated for those with evidence humoral immune dysfunction. This is typically evaluated in a T cell independent fashion using a pneumovax as a challenge mechanism (or possibly Salmonella typhi vaccine which is also polysaccharide). Poor response to prevnar is ...
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Answer from: at Academic Institution
If the patient has recurrent/chronic infections (check her sinuses as well, to help rule out other forms of pneumonitis), and other diagnoses such as CF have been ruled out, then her diagnosis may be specific (polysaccharide) antibody deficiency and IgG augmentation might be necessary. Given her rel...
Answer from: at Academic Institution
Yes!